Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 095184 | NY |
Y | 1041C0700X | Clinical Social Worker | 087472 | NY |
NPI | 1003358086 |
---|---|
Provider Name | Jasmin Raidoo |
First Address | Saratoga Springs, NY 12866-4226 |
Second Address | Albany, NY 12208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2016 |
Last Update Date | 27/09/2019 |